A book about Borderline Personality Disorder.

"Loneliness, fear of abandonment, impulsive self destructiveness, storminess in relationships, inability to achieve intimacy - these are feelings that we all experience at one time or another. The borderline personality, however, lives with these feelings almost constantly and experiences them to a much higher degree." - Preface

"Borderline confusion often results in contradictory messages to others. Frequently, the borderline will communicate one position with words, but express a contradictory message with behavior. Although the borderline may not be consciously aware of this dilemma, he frequently places a friend or relation in a no-win situation in which the other person is condemned no matter which way he goes." - page 102

"For many, American culture has lost contact with the past and remains unconnected to the future. Our flooding of technical advancement and information requires greater individual commitment to solitary study and practice, thus sacrificing opportunities for socialization. Increasing divorce rates, expanding use of day care, and greater mobility have all contributed to a society that lacks constancy and reliability. Personal, intimate relationships become difficult or even impossible to achieve, and deep-seated loneliness, self-absorption, emptiness, anxiety, depression, and loss of self-esteem ensue." - Page 63

"The borderline lacks the boots, much less the bootstraps, with which to pull himself up. It is useless to get angry or to cajole and plead with the borderline to change; without help he is bereft of the tools to alter his behavior...He must accept, without being excused or protected, the real consequences of his actions, even though initially he may be powerless to alter them...Those who interact with a borderline must attempt to walk a very thin line between, on the one hand, providing reassurance of the borderline's worthiness and, on the other, confirming the necessary expectations." - Page 154-155

Relationship Difficulties: Quite Benign or Warning Signs?

No matter how wonderful and special your relationship may be, there is always some downside. The same partner who gives you butterflies when you even picture them in your mind will at times fill you with tension and frustration. The person who inspires a heartwarming sense of closeness will periodically seem distant, leaving you with the dull ache of loneliness. The one whose quirky sense of humor and adorable mannerisms bring a joyful smile to your face will later leave you weary and exasperated when they leave the cap off the toothpaste or forget to put the toilet seat down yet again. Indeed, it only takes one close relationship to learn the true meaning of the phrase "nobody's perfect". Whether it's their inability to distinguish the floor from the garbage bag, the intolerable in-laws, or the fact that you can read War and Peace in the time it takes them to get ready to go out, we can always find something upsetting in any relationship on which to focus.

In most cases, these manageable aches and pains contrast with rewarding feelings of intimacy and shared happiness to create a healthy balance. But, when these normal ups and downs become more intense and erratic, it can leave you feeling bitter, angry, and even helpless. If your past or present relationships have had more than their share of turbulence and uncertainty, you may be dealing with a more specific, widespread and well-established, though often unrecognized, problem.

Have you ever begun a relationship with someone who seemed like a match made in heaven - perhaps even "the one" - only to experience devastating disappointment as fights and disagreements started to spring suddenly out of nowhere? Did your partner waver unpredictably between possessively clinging and hurtfully pushing you away, leaving you utterly confused? Did this person go from bubbly to angry to sad and back in a matter of hours, entrapping you on an emotional roller coaster, where you were loved one day and despised the next? Was everything black and white, all or nothing, love or hate, ecstacy or despair, with few in-betweens? Did you begin to hear the stories of the abusive parents, the neglectful family, the revolving door of transient jobs, "uncooperative" bosses and co-workers, or intense, fleeting romances - or in the worst cases the self-destructive eating disorders, gambling, cutting, or suicidal threats and attempts?

Perhaps you have been lucky enough in love that this scenario, familiar to all too many of us, seems strange or even unbelievable. But, if a moment's reflection conjures up a similar experience in any of your past or present relationships - or those of people close to you - then you are undoubtledly familiar with the pain, confusion and powerlessness that so many have suffered in the grips of such a relationship. And, like so many of them, you will find hope and practical solutions that could save you months or years of agony in I Hate You, Don't Leave Me by Jerold J. Kreisman, M.D. and Hal Straus.

A Familiar Relationship Pattern?

"...he caroms back and forth from clinging dependency to angry manipulation, from outpourings of gratitude to irrational hate. He fears abandonment, so he clings; he fears engulfment, so he pushes away. He craves intimacy and is terrified of it at the same time. He winds up repelling those with whom he most wants to connect." - Page 12 of I Hate You, Don't Leave Me

Even if the previous scenario's familiarity makes you wonder if we've bugged your partner's home, you may still be unsure whether your relationship is truly problematic. It is hard for any of us to identify the exact line between healthy relationship issues and deeper troubles, or to admit that our partner may have a serious problem. Yet, it is crucial for both our own sake, as well as that of our partner, to recognize when such a problem exists. Therefore, it is helpful to take a much deeper look at the stereotypical pattern of a relationship involving the problem focused on by I Hate You, Don't Leave Me.

While this pattern involves several large and obvious behaviors, it is also important to note that, often, small quirks that we overlook are actually indicators of a larger pattern. Since it is a stereotype, as you read through the following scenario, you may not feel that your partner, past or present, displays all of the qualities described. However, if the following progression of stages seems like a journal of your relationship, then I Hate You, Don't Leave Me will definitely be of great interest to you.

Stage 1: From Intimate Connection to Pressure and Games

It starts with a bang. You meet someone to whom you are powerfully drawn, a person with whom you can be completely open and comfortable, and who seems to feel the same way with you. Passionate or dramatic, this person makes you feel excited and alive. They make you feel unique and special, complimenting you often, and pulling you very close to them. Things are good and your imagination slowly begins to soar with visions of a beautiful future together. Could this be "the one"?

But, gradually, a tone of jealously addictive clinging emerges, as you feel this person starting to seek your constant attention and reassurance. "Do I look good enough?" they ask. "Am I smart enough?" You feel pressured to play an increasingly central emotional role in this person's life, as they seem engaged in a desperate attempt to fill a hole in themselves - a lack of self-esteem - with your approval. You sense a constant need to prove yourself, as you are subjected to silly emotional tests and games designed to confirm your continued validation. Yet, oddly, when you do praise them, they brush it suspiciously or distrustfully aside, refusing to accept their good qualities, explaining them away. They may describe feeling that they are "faking it", worrying that they will be "found out" as a fraud, and even extending into self-hate. They may even start to become controlling, trying to keep you from seeing other friends.

Stage 2: Walking on Eggshells - The Confusion and Anger of a No-Win Situation

Clearly, you suffer during the difficult times in the relationship, but because of this person's wonderful qualities and memories of the times when you felt connected, you continue to open yourself up and gradually feel closer. Just as you do, you sense this person begin to push you away suddenly and inexplicably. They begin to sabotage the relationship, blowing miniscule events and problems out of proportion, blaming you for things when you did nothing wrong, giving you contradictory messages, and leaving you in a no-win situation where you're damned if you do and damned if you don't.

You begin to feel like you are constantly walking on eggshells around this person. When there is no excuse for sabotage, they make one up, intentionally provoking problems and creating self-fulfilling prophecies. Terrified that you'll leave, they provoke preemptive rejections, trying to leave you before you leave them. They purposefully push your buttons, then get mad when you respond with justified and perfectly reasonable discontent. "Am I to blame here? Am I doing something wrong?" you begin to wonder. A confused mixture of anger, sadness and love are surfacing.

Stage 3: Riding the Emotional Roller Coaster

"They love without measure those whom they will soon hate without reason." - Thomas Sydenham, 17th century physician quoted on Page 17 of I Hate You, Don't Leave Me

Despite your desire to be close, these confused feelings finally cause you to back off a bit to gain some space. When you do, they may accuse you of abandoning them, express deep-seated fear of being alone, beg your forgiveness, or strangely act as if nothing happened. You notice things returning to the way they were in the beginning, as they resume pulling you close, only to once again push you away in an increasingly predictable cycle of sudden mood changes. You experience an emotional roller coaster of joy and pain, as this person alternately pulls you near and pushes you away, until you begin to wonder which of these two people is the "real" one. They may change drastically from high to low in a matter of hours, an emotional chameleon, seemingly possessed by contradictory personalities and beliefs at various times.

Stage 4: From Hero to Villain and Back - A Black and White View

"She'll change so suddenly, she's just like Mercury...she's entwined in me, crazy as can be." - "Mercury" from Recovering the Satellites by Counting Crows

Even as you view this person as constantly changing, they seem to view you the same way, though with no real justification. One day they see you as good, even idolize you. The next, they seem to have forgotten all of the good things you did before, reacting only to your most recent negative encounter - no matter how trivial - and suddenly you are cast inexplicably as the villain. This pattern is also carried out with others, whom the person may describe as "all good" or "all bad" and who may have similarly contradictory views in return.

Some acquaintances see this person as sweet and nice, and may even doubt your explanation of the relationship's difficulties. Others see this dramatic person - who, like an actor, takes on different roles in different situations - as manipulative and calculating. You begin to see their childlike pattern of viewing things in black and white - all good and all bad, without shades of gray - applied to many areas of life. Furthermore, their inability to integrate past events with the present may manifest in a habit of staring at pictures of people to "keep them alive in their brain" or carrying "security blankets" to remind them of people or places.

You keep hoping that things will return to the way they were at the start. Furthermore, you harbor a deep, almost protective desire to help this person, for whom you still feel much warmth and compassion, and who truly seems to need you. As things progress, more serious issues start coming to the surface. The person may exhibit a patchy job history, with frequent changes due to "personality conflicts" or disruption of previously comfortable routines. Particularly drawn to highly structured situations, or the helping professions like medicine, nursing, or counseling, they seem unable to adapt when any job becomes too undirected.

You may learn of an unstable, problematic family history with either absent or divorced parents or overbearing, suffocating ones. Past emotional, physical or sexual abuse, an overlapping chain of intense, unstable, and manipulative relationships, and a destructive ongoing attraction to such unhealthy situations may become apparent. They seem to prefer even being abused to being alone, starting one new relationship before the last one is even over, frantically avoiding even temporary isolation, which they find intolerable.

Yet, as you hold this person close, compassionately rescuing them from the isolation they fear, they may then harshly and unappreciatively shove you aside in favor of someone who treats them terribly. They may seem to reward those who tell them the negative that they want to hear, while punishing you when you tell the positive or well-intentioned truth. As a result, you may feel like the impotent victim of an extremely undeserved retaliation for this person's past abuses at the hands of others. They take an extremely selfish view of love, often blurring its border with pain. Indeed, for all of their relationship-hopping drama, they seem to see real love as impossible, complaining that they can't find it, or that it doesn't even exist.

Stage 6: The Vicious Cycle of Self Destruction

Even more seriously, you may eventually learn that this person is engaged in a pattern of impulsive, self-destructive behaviors, in an attempt to feel more alive, administer self-punishment, or to cry out for help - which is simultaneously needed and resisted. You may recognize them abusing alcohol or drugs, shoplifting, or going on rampant spending or gambling sprees. They may display to you the signs of being anorexic, shunning nearly all food, or bulimic, vomiting regularly after they eat, in the attempt to attain a sickly slender figure.

The person may exhibit signs of self-mutilation, and you may see or be shown self-inflicted cuts on their body. They may even express a sense of relief, rather than pain, upon carrying out these acts. You may hear tales of promiscuity, including sexual perversions - sometimes painful - along with the use of sex for attention or manipulation. Often, this person later feels guilty about these actions, leading to a further vicious cycle of depression, punishing self-destruction, immature tantrums, and possibly even rage and violence.

Stage 7: Manipulative Suicidal Tendencies and Irresponsibility

Ultimately, this person may confess to you a history of suicide attempts, motivated by an empty, disinterested boredom with life. They may even manipulatively threaten you with - or actually carry out - another attempt. Overdose, slitting the wrists, or any other means can be used as a cry for attention or concern. You may learn of a history of being shuffled between therapists, doctors, medications, or hospitals without any solid resolution of their problems. Yet when you try to talk about these issues, they "shut down" or get very defensive.

Feeling sympathetic, you may desire to rescue them from their victim role, and in the process hope to gain their appreciation and affection. You may offer solutions, but they refuse to take any actions or responsibility to help themselves. They prefer to create guilt, fear and anger in others by projecting blame onto them - often absurdly - and thrusting the burden of decisions onto them. A frustrating unwillingness or inability to commit to and follow through with goals emerges. You may, at last, begin to feel that they are taking advantage of your sympathy. That old question rears its head: "Should I stay or should I go?"

Breaking Up is Hard to Do, Understanding is Easier

Given the pain of such a situation, most would say your best bet is to leave and simply find someone healthier. But, anyone who has been close to someone like this knows it's not always that easy. Firstly, you may find yourself running across this pattern repeatedly, even seeming to be a magnet for such personalities. Secondly, you may truly care about this person and not want to abandon them. Thus, for both your sake and theirs, it is extremely important for you to learn more about what is behind this increasingly common pattern of behavior. Imagine if you could pick up a book, read it in one or two sittings, and suddenly all of this could make sense.

I Hate You, Don't Leave Me by Jerold J. Kreisman, M.D. (assistant clinical professor for the department of psychiatry at St. Louis University) and Hal Straus (a health writer) is just the book to give you that understanding and save you untold hours of confusion and pain. It describes in layman's terms one of the most common, yet undiscussed, conditions in our society - Borderline Personality Disorder (BPD). Even those most skeptical of psychiatry and self-help will recognize its pattern in family members, friends, lovers and even themselves as they read.

If the frustrating and difficult situations described earlier strongly evoke such memories for you, Borderline Personality Disorder or its traits may be central to the problem. While it is always painful to learn that someone we care about has a "disorder", it is also through such precise identification that we receive direction towards the support of others similarly effected, resources that can help, and ultimately the peace of mind that results from true understanding of previously confounding and upsetting situations.

Borderline Personality Disorder is an established psychiatric disorder, with strictly defined criteria, which can encompass more specific problems including alcoholism, bipolar disorder, drug abuse, eating disorders, suicide, and many others. While each of these more specific problems are important to treat in their own right, the recognition that each is the result of a greater overall problem - the borderline personality - is crucial for successful coping and treatment.

Because of its widespread prevalence, its common lack of recognition or incomplete diagnosis, its resistance to purely symptomatic treatments, its related abuse and self-destruction, and its likelihood of leading to suicide (8-10% of borderlines commit suicide, while many more make frequent attempts), it causes sympathy and confused pain for literally millions of people. I Hate You, Don't Leave Me describes how you can tell if someone you care about is borderline, why it is such a growing problem, and how best to help both the borderline individual and yourself.

"But They Don't Seem Crazy"

"Can this person really be borderline?" you might ask. "He or she doesn't appear 'mentally ill'." Kreisman and Straus caution you not to be fooled into expecting the borderline to always resemble the stereotypical "crazy" persona. They may function quite well and are often very intelligent, even brilliant, doctors, lawyers, and other professionals. A borderline may be very difficult to pick out in a crowd, and often seems quite "normal" at work and in social situations, though they may secretly be expending great energy to function at such a level. Indeed, others who know this person may even doubt your description of their troubles and difficulties since they remain unfamiliar with that side of them.

Borderline: More Likely Than You Think

You might be asking yourself how likely it could be that this person is borderline. After all, you've probably never heard of this condition. Yet, despite the fact that the average person is not familiar with BPD, it is extremely prevalent. Affecting an estimated 2% of the population (Over 6 million in the U.S. alone), and suspected of actually affecting far more, it is by far the most common personality disorder. It affects every socioeconomic class, and is seen in every area of the U.S. and many other countries. Thus, it is actually quite likely that you know several people who are borderlines. BPD is thought to be significantly more common in women, and because of the resulting series of tumultuous "chain relationships", it further increases the chances that you may become involved with someone who is affected.

"Each culture probably needs its own scapegoats as expressions of society's ills. Just as the hysterics of Freud's day exemplified the sexual repression of that era, the borderline, whose identity is split into many pieces, represents the fracturing of stable units in our society." - New York Times writer Louis Sass quoted on page 64 of I Hate You, Don't Leave Me

Being so common, and perhaps recognizing this pattern in so many people, you may be tempted to wonder if this is actually just normal behavior. But, despite how widespread it is, self-mutilation, suicidal gestures, and terrifying fear of abandonment, to name just a few, are not normal, healthy human behaviors. How can it be that so many people are affected by such an unhealthy pattern that it has begun to appear almost normal?

In perhaps the most fascinating chapter of all, "The Borderline Society", I Hate You, Don't Leave Me details the roots of this pattern of behaviors as reflected in our current social patterns and our era's culture at large. Kreisman and Straus illuminate the way in which widespread BPD serves as an indicator of some very troubling trends in the way we live. They give striking evidence that these borderline traits are being bred on a wide scale by our fragmented society and crumbling social structures.

For example, more children than ever grow up in families that are constantly changing location. Thus, many develop a lack of constancy, losing sense of where home really is, and being forced to adapt to a new identity with each move, prefacing the uncertain identity of the borderline. Meanwhile, rampant divorce also leaves children in difficult shifting identity situations, often serving as a pawn between the two parents, without consistent role modeling from both, and often without a father closely involved at all. Parents' attempts to replace quality closeness with a growing arsenal of toys, television and empty scheduled events further deprives the children of the real identity formation and structure that they need.

The book also examines the under-appreciated potential role of raising an entire generation of children in day care - a system unheard of in the thousands of years of human history - in weakening identity formation in our children. As the increasing concentration of wealth makes two-parent income a necessity, rather than an option, and women and men explore different family roles, both the parents and children become prone to confusing identity roles that mirror that of the borderline. In the worst of cases, whole families can become borderline-type systems, and this can culminate in the abuse and neglect that are such common precursors to Borderline Personality Disorder.

The risk factors for such traits manifest on a larger social scale in our culture, as well. In the microcosm, children grow up in a world of common teenage drug and alcohol use, while in the macrocosm, war, crime and terrorism leave a frightening sense of instability. Overspecialization and technology leave many fearing abandonment or expendability in their jobs. Like the borderline, our society is full of contradictions, such as those between our love of peace and our ever-present glorification of violence on television - not to mention by our leaders - or between our admiration for generosity co-existing with one of the most selfishly materialistic societies ever on earth. Our President's constant, and often shifting, split of the world into heroes and villains - good and evil-doers - combined with the striking contrast between our fabulously wealthy and our desperately impoverished citizens recalls the black-and-white splitting that is a hallmark of BPD.

The borderline is caught in a constant present, a cycle of shifting identity, unable to integrate their past understanding with the newer facts of today. This trait is strikingly similar to the lost sense of history and constantly shifting identity that marked everyday life in America's last century. We barely seem to realize how strange this extreme volatility is in the course of human history. While we are nostalgic for the past, we set aside very little time for deep and honest reflection. Our day-to-day lives change at a remarkable pace, leaving each generation increasingly isolated from yesterday's culture, which seems laughably outdated the next day.

The heretofore smooth flow of generation into generation that has marked cultures for thousands of years has been broken into a choppy, disorganized frenzy. This is exacerbated by the breakdown of the extended family, which prevents the child from establishing concrete identification with his elder ancestors, as well as breaking their historical link to the past. Meanwhile, the link to the future, which would ideally create a sense of security, is under constant attack by the threat of nuclear annihilation, making impulsive actions that undermine future generations frighteningly comprehensible.

While many of these changes have led to increased freedom, we may be paying dearly for them. Just as our unhealthy diet has led to widespread heart disease, Kreisman and Straus make a compelling argument that borderline-type disorders may be the pandemic effect of our unhealthy social and cultural environment, with its disconnected desire for constant change contradicted by its inability to embrace uncertainty. Because of all this, BPD promises to grow even more prevalent, making it increasingly likely that you will continue to encounter such personalities in the future. Thus, it is even more helpful to understand this person and relieve yourself of the burden of self-blame as you learn the true roots of such behavior.

Borderline Factors And Actors

This short book also discusses how age, biology, socioeconomic status, and the various stages of childhood and adolescent development are related to BPD, and how its problems manifest in the workplace, at home, and elsewhere. Famous people who have exhibited borderline traits are discussed ranging from real to fictional characters such as:

Special attention is given to Marilyn Monroe, whose childhood in an orphanage led her to a constant search for an identity and a father figure, and played out in borderline fashion, ultimately leading to suicide. If you have had close contact with someone who is borderline, these examples will fill you with a sense of deja vu.

Beyond Blame to Constructive Communication and Action

Upon finishing I Hate You, Don't Leave Me, you will be filled with a sense of sympathy for those who suffer from this disorder, and by stepping into their shoes you will gain a deeper understanding of previously painful and perplexing events. Moreover, you will experience a marked sense of relief that you are not to blame for their mood swings and often hurtful behavior. You will understand how feeling frighteningly alone, misunderstood, and helpless - rather than malice - drive the borderline's behavior. All of this will put you in a more powerful position from which to act and communicate more appropriately.

To give you practical tools, Kreisman and Straus describe a tested system for communicating effectively with a borderline. Until now, you may have been caught up in no-win cycles of fighting and conflict, been alternately built up and then torn down again, and been accused of not caring or understanding. If so, this method offers a way to move into constructive dialogue, expressing both care and responsibility, and leading to insight and action at the root of the problem.

Once you have this awareness and the tools with which to handle it, you will be better prepared to revisit that difficult decision: "Should I stay or should I go?" If you feel you have the energy, and the person means enough to you to stay, this book will enlighten you about the long haul ahead and how you can help this person without taking on their responsibilities. It will explain what to expect, how to avoid verbal arguments that only worsen the situation, and how to deal with mood swings, rage, impulsive self-destructive behaviors, or even suicidal tendencies, threats, and attempts. It will tell you where and when to seek professional help, and discusses various therapies that can help a borderline to explore the often abusive roots of their problems and cope with them. This can assist them in coming to terms with family, history, uncertainty, and the extraordinary challenge posed to such a person by change. I Hate You, Don't Leave Me will also inform you as to when even more structured help or hospitalization may be necessary to give the person freedom to reflect and heal, as well as to offer supportive boundaries and limits.

Beyond Fear to Hope

"Psychological change requires resisting unproductive automatic reflexes and consciously and willfully choosing other alternatives - choices that are different, even opposite, from the automatic reflex - sometimes these new ways of behaving are frightening, but they hopefully are more efficient ways of coping." - Page 90 of I Hate You, Don't Leave Me

Unlike many more familiar disorders, BPD is not usually solved simply with medication - it requires a more holistic approach. Even an often miserable state like this becomes comfortable after a while, and you may find this person to be scared of change. But with time, and your support, they can learn to question long-hardened instincts and act in spite of them. You may save this person years of being shuffled around the medical system by letting them know that the problem might be BPD, so that they can pass the information along to those who can help.

With such proper diagnosis and treatment, the borderline can learn to take more responsibility for themselves, accepting their imperfections and negative feelings and those of others as part of the complexity of human nature. They can establish a more solid, trusting identity, leading to inner contentment based in personal interests, relationships based on common ground rather than desperation, and a view of life as a flow of time, rather than a snapshot. By finding a healthy balance between their usual extremes, they can weather the difficult process of limping towards more adaptive habits and reflexes, while resisting their previous destructive ones, until adaptation becomes second nature. Meanwhile, you can learn how to adjust along with this person to maintain a fruitful, if often difficult, relationship.

Lessons for the Future

Alternatively, I Hate You, Don't Leave Me may help you realize that you are not prepared for the long and difficult commitment that a borderline represents. If this is the case, the decision to leave could save you months or even years of agony in the cycle of pull and push and constant manipulation and abuse. You will also come to understand why, in many cases, leaving is the best possible solution not only for you, but also for the borderline. Either way, you will feel better prepared for a situation that you may run into again in relationships in the future. Furthermore, you will gain insight into yourself, exploring issues that we all experience on a more moderate level than the borderline. Finally, Kreisman and Straus will enable you to question which behaviors you are truly doing unselfishly for this person, and which are actually an attempt to seek out affection and validation for yourself.

As you continue down the long road of love, it is important to realize that not every person who is depressed or drinks or threatens suicide is borderline. They may just have depression or alcoholism, or they may simply be going through a rough period in life. Diagnosing such a disorder should be left to the professionals. But, if you see several of the signs discussed here, it may well be this most common of personality disorders. By helping you to recognize this possibility, I Hate You, Don't Leave Me is a book that may save you a lot of time and wasted, misguided pain in dealing with a loved one or anyone else who fits this pattern.